title: Argon plasma coagulation therapy versus topical formalin for intractable rectal bleeding and anorectal dysfunction after radiation therapy for prostate carcinoma.
abstract: OBJECTIVE
  To evaluate and compare the effect of argon plasma coagulation (APC) and topical formalin for intractable rectal bleeding and anorectal dysfunction associated with chronic radiation proctitis.
  
  
  METHODS
  Thirty men (median age, 72 years; range, 49-87 years) with intractable rectal bleeding (defined as ≥1× per week and/or requiring blood transfusions) after radiation therapy for prostate carcinoma were randomized to treatment with APC (n=17) or topical formalin (n=13). Each patient underwent evaluations of (1) anorectal symptoms (validated questionnaires, including modified Late Effects in Normal Tissues-Subjective, Objective, Management, and Analytic and visual analogue scales for rectal bleeding); (2) anorectal motor and sensory function (manometry and graded rectal balloon distension); and (3) anal sphincteric morphology (endoanal ultrasound) before and after the treatment endpoint (defined as reduction in rectal bleeding to 1× per month or better, reduction in visual analogue scales to ≤25 mm, and no longer needing blood transfusions).
  
  
  RESULTS
  The treatment endpoint was achieved in 94% of the APC group and 100% of the topical formalin group after a median (range) of 2 (1-5) sessions of either treatment. After a follow-up duration of 111 (29-170) months, only 1 patient in each group needed further treatment. Reductions in rectal compliance and volumes of sensory perception occurred after APC, but no effect on anorectal symptoms other than rectal bleeding was observed. There were no differences between APC and topical formalin for anorectal symptoms and function, nor for anal sphincteric morphology.
  
  
  CONCLUSIONS
  Argon plasma coagulation and topical formalin had comparable efficacy in the durable control of rectal bleeding associated with chronic radiation proctitis but had no beneficial effect on anorectal dysfunction.
authors.affiliation: Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia. Electronic address: eric.yeoh@health.sa.gov.au.
authors.forename: Eric
authors.initials: E
authors.lastname: Yeoh
authors.forename: William
authors.initials: W
authors.lastname: Tam
authors.forename: Mark
authors.initials: M
authors.lastname: Schoeman
authors.forename: James
authors.initials: J
authors.lastname: Moore
authors.forename: Michelle
authors.initials: M
authors.lastname: Thomas
authors.forename: Rochelle
authors.initials: R
authors.lastname: Botten
authors.forename: Addolorata
authors.initials: A
authors.lastname: Di Matteo
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000503:physiopathology / Q000528:radiation effects*; D057908:Argon Plasma Coagulation / Q000379:methods*; D003029:Coagulants / Q000008:administration & dosage*; D005557:Formaldehyde / Q000008:administration & dosage*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000150:complications*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012007:Rectum / Q000503:physiopathology / Q000528:radiation effects*; D012677:Sensation / Q000502:physiology / Q000528:radiation effects
chemical_list: D003029:Coagulants; D005557:Formaldehyde